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FOE OF,--;CE v ,f ' I APPLICATION FOR SANITATION P! "T (Compiete in Triplicate) remit No. . . . . . ......... This Permit Expires I Year From. Date Issued Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the •.vori: her in described. This applicc;ion is/made in compliance v,,4N*h County KOrdina ce No, 549 and existing Pules and Reguiatior.s: JOB ADDRESS/LOCATION (!/. 1----- V- ----------------- CENSUS TRACT Owner's Name -------- - --------- -• -Phone _ - .......... - ----------- ---- ..� Address ---------- ---------. City -- Contractor's Name ..._. _..- _ . . ___-_- License #��. �_- Phone ._ Installation will will serve: Residence XApartment House ❑ Commercial ❑Trailer Court ;[) Motel u Other - - Number of living units:.. Number of bedrooms -.___Garbage Grinder ------------ Lot Size ------Z__ . Water Supply: Public System and name --------------_--__ T__ __ �__ _ Private Character of soil too deptF�of 3 feet: Sand T] Silt❑ Clay [I Peat❑ Sandy Loam E] Clay Loam Hardpan I—! Adobe ❑ Fill Material Ifes, Y type ----------------------- -- (Plot (Plot plan, show:rng-size of lot, location•-of system-in relation to welis, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) \ PACKAGE TREATMENT [ 7 SEPTIC TANK [ j Size----- ----.__-__ _ -. --.-------__ _ Liquid Depth -- Capacity ._ .---- --- Type -------------------- Material---.- - --- --.._-- No. Compartments _ ----------- V- to nearest: Weil -------------- --------- - - - -----Foundation ..------------------- Prop. Line ...................... LEACHING LINE [ ]t, No. of Lines ---.-----..------....._ Length of each line.----�__--__-__ ----- Total Length ............................ 'D' Box ---- - . Type Filter Material ----------------- Filter Material Distance to nearest: Well -_-_..... ....... ... Foundation Property Line .._ SEEPAGE PIT [ 1 Depth ... Diameter Number Rock Filled Yes O rvo Water Table Depth ...........................---------------------Rock Size ------ Distance to nearest: Well ---- Foundation -------------------------- •----•-------------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------- -----... Date ___________________•______________) -----------------•------ Septic Tank (Specify Requirements) .-...-_ Disposal Field (Specify Requirements) -__.-.. _ _ /7 __ - - - u U -- - -------------•---- ................ ------------ (Draw existing and required addition on reverse side) --------- ..- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Reguiations of the Sar, Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "' certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become sul�iect to Workman's Compensation laws of California." c � Sianed ._ . .-`�------1-•__N. '�- �t Owner By -- ------ -- -- - (If other than owner) - -------- --... --------- .i--------------•--------- itie .--------- -------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING - --••-•--- ....................................... DATE ---1.�_-/..7_`_C'� 5UILDING PERMIT ISSUED ._______________ � - -- ----•-••----•--•-----•-----•.......... ...........................................DATE -------•---•---------- ----.. .... ------------- ADDITIONAL COMMENTS.._____________________ •• - ---------- -----------------•- ----- -- - ------ •-----••--• -----------•-•----•------------•--•• ------- Final Inspection by. ....:_ i�« '�-- Date ��, - _.t- - ---- ` -- SAN JOAQUIN LOCAL 'HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M